Patient selection for left ventricular assist devices.
Mechanical circulatory support has become an increasingly common method of supporting patients with advanced heart failure. Paramount to the recent progress observed with this therapy has been a greater understanding of patient selection criteria as a primary determinant of early and late patient outcomes. Prior to device implant, patients should undergo a multidisciplinary evaluation of cardiovascular, noncardiovascular, and psychosocial factors that influence postoperative outcomes. The use of multivariable risk scores may also be useful to guide discussions with patients and families regarding the relative risks of different therapeutic alternatives. Despite an evidence base that provides guiding principles in patient selection for mechanically assisted circulation, several aspects of the evaluation require further refinement, including development of tools to objectively assess psychosocial parameters, and definition and validation of measures of right ventricular dysfunction that preclude successful isolated left ventricular support.
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